ECHOCARDIOGRAPHIC ASSESSMENT OF AORTIC REGURGITATION

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Presentation transcript:

ECHOCARDIOGRAPHIC ASSESSMENT OF AORTIC REGURGITATION

SEVERITY 1. Regurgitant jet width/LVOT diameter ratio greater than or equal to 60 percent 2. Vena contracta greater than 6 mm 3. Regurgitant jet area/LVOT area ratio greater than or equal to 60 percent 4. Aortic regurgitation pressure half-time less than or equal to 250 ms 5. Holodiastolic flow reversal in the descending thoracic or abdominal aorta 6. Regurgitant volume greater than or equal to 60 mL 7. Regurgitant fraction greater than or equal to 50 percent 8. Effective regurgitant orifice greater than or equal to 0.30cm2 9. Restrictive mitral flow pattern (usually in acute setting)

Regurgitant jet height measured as maximal diameter of regurgitant jet just below AV,PLAX view LVOT diameter in end diastole

Regurgitant jet width/LVOT diameter ratio greater than or equal to 60 percent

Vena contracta greater than 6 mm

Regurgitant jet area measured from PSAX view at level of LVOT LVOA measured at end diastole at same site Ratio calculated

Regurgitant doppler signal is a function of pressure gradient between aorta and LV Mild AR –small increase in LVEDP-gradual decline and flat deceleration slope Severe AR –LVEDP rises rapidly-rapid decline

Suprasternal window-descending aortic flow profile Short period of low velocity flow reversal-normal Pan diastolic flow reversal with end diastolic velocity>20cm/s

Calculation of R.Volume and R.fraction SV=CSAxVTI R.Volume=SV[lvot]-SV[mv] RF=R.Volume/SV[lvot] ERO=R.Volume/VTI[ARjet] R.V>60ml,RF>50%,ERO>0.3cm² indicate severe AR

Restrictive mitral flow pattern

MILD MODERATE SEVERE Jet width/LVOT diameter <25% >/=65% Vena contracta <3mm >/=6mm Jet area/LVOT area <5% >60% PHT >500 ms </= 250ms Holodiastolic flow reversal present

MILD MODERATE SEVERE Reg vol < 30 ml >/= 60 ml Reg fraction < 30 % >/= 50% ERO < 0.1 cm2 >/= 0.3 cm2 Mitral inflow restriction Present

Extent of jet

Signal intensity

ACUTE VS CHRONIC Shape of the envelope CW doppler Rate of deceleration of flow Premature mitral valve closure Endocarditis,dissection Normal lv dimensions

LV chamber dimensions LV systolic function Aortic root dilatation

Thank you